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# Diclofenac (Oral)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 150 mg to 200 mg per day in 2 to 4 divided doses. Doses of 75 mg per day can be given in 2 or 3 divided doses. The maximum recommended daily dose is 200 mg.
* **Acute Pain:** 200 mg on the first day of treatment, followed by 150 mg per day for the remainder of the treatment period, given in divided doses.
* **Primary Dysmenorrhea:** 100 mg on the first day of treatment, followed by 50 mg every 8 hours as needed, for up to 3 days. Doses higher than 100 mg per day are not recommended.
## Pediatric Dosing
* Not generally recommended for use in pediatric patients. Limited data available.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. In patients with mild to moderate hepatic impairment, a reduction in dose may be warranted. Diclofenac is contraindicated in severe hepatic impairment.
* **Renal Impairment:** Use with caution. In patients with mild to moderate renal impairment, a reduction in dose may be warranted. Diclofenac is contraindicated in severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe hepatic impairment.
* Severe renal impairment.
## Adverse Effects
Common adverse effects include:
* Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, abdominal pain)
* Dizziness
* Headache
* Rash
* Edema
* Increased liver enzymes
* Increased blood pressure
Serious adverse effects include:
* Cardiovascular thrombotic events (myocardial infarction, stroke)
* Gastrointestinal perforation, ulceration, and bleeding
* Hepatotoxicity
* Renal toxicity
* Anaphylactic reactions
* Serious skin reactions
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly gastrointestinal.
* **Diuretics, ACE inhibitors, Angiotensin II receptor blockers:** May reduce antihypertensive efficacy and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum concentrations and toxicity.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease or those at risk of renal impairment.
* **Hepatic function:** Especially in patients with pre-existing liver disease or those receiving long-term therapy.
* **Blood pressure:** NSAIDs can increase blood pressure.
* **Signs of gastrointestinal bleeding:** Occult blood in stool, melena, hematemesis.
* **Signs of cardiovascular events.**
## Clinical Pearls
* Take with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Avoid concurrent use with other NSAIDs.
* Patients with cardiovascular disease or risk factors for cardiovascular disease should be carefully evaluated before use.
* Consider gastroprotective agents (e.g., proton pump inhibitors) in patients at increased risk of gastrointestinal bleeding.
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
